Neurovascular Intervention

A stroke is a medical condition in which blood flow to the brain is disrupted, leading to the death of cells in the brain. With immediate treatment, a patient suffering from Stroke has a high chance of surviving and recovering. Stroke affects the normal functioning of the brain such as speech, thinking, mobility, and vision just to name a few. The main types of stroke are ischemic, caused by strained blood flow, and hemorrhagic, caused by bleeding. Here are 7 important facts about stroke that everyone should know.

This course provides attendees with an update on all major areas of clinical interest in vascular neurology. Lectures cover management of acute ischemic stroke, brain hemorrhage, and symptomatic and asymptomatic vascular lesions including arteriovenous malformations, cavernous malformations, cerebral aneurysms and carotid stenosis. The latest diagnostic and therapeutic approaches to stroke are discussed. Lectures are supplemented with highlights of images in clinical vascular neurology and group discussions of clinical vignettes.

Thrombectomy is a technique that has completely changed the management of acute stroke and current devices have shown that they can achieve upwards of 90% successful recanalization in selected cohorts. However, despite the effectiveness of these devices, there are a proportion of patients who still …

Research published recently in JAMA Neurology sought to answer whether there were significant differences in treatment outcomes of a stent retriever combined with local aspiration-based mechanical thrombectomy versus aspiration-based thrombectomy alone in large vessel occlusion (LVO) stroke.

Various mechanical thrombectomy devices including stent retrievers (STRs), contact aspiration (CA) catheters, and balloon guide catheters (BGCs) are used in both isolation and combination for the treatment of acute ischemic stroke. A new generation of Super‐Bore 088″ aspiration catheters are being trialed clinically. We evaluated the in vitro revascularization performance of current and novel thrombectomy approaches in treating soft (red blood cell–rich) and stiff (fibrin/platelet‐rich) clots at internal carotid artery (ICA) and middle cerebral artery (MCA) occlusion sites.

The two main possible types of devices for thrombectomies are the stent retriever or the aspiration catheter. In the first positive randomized controlled trials for mechanical thrombectomy in acute ischemic occlusions with large vessel occlusions, a majority used the stent retriever as the first-line device: primarily the Solitaire stent (Medtronic, Irvine, California, USA) or the Trevo stent (Stryker, Fremont, California, USA).

The Clotild device uses a database centered around clots with a known composition. This database has been used to train a machine-learning model capable of recognizing different compositions, which is then able to predict composition in unknown clots, Rice reported. He also claimed that this use of electrical impedance spectroscopy presents a novel means for characterising occlusions in stroke, with data having shown continued coherence through ex vivo, animal and early in-human research thus far.

Much has been said about the long-term effects of coronavirus disease 2019 (COVID-19), including neurological side effects. A new study compares the rates of onset of several types of neurological illness, whether degenerative, stroke-related or immunological, after COVID-19 or other respiratory infections.

The researchers found that 30.3 and 67.7 percent of 1,125 participants had no major vascular risk factors and had at least one previously undiagnosed major vascular risk factor, respectively. Dyslipidemia, hypertension, atrial fibrillation, diabetes mellitus, ejection fraction <35 percent, and coronary disease were newly detected major vascular risk factors (seen in 61.4, 23.7, 10.2, 5.2, 2.0, and 1.0 percent of patients, respectively). Positive associations with previously undiagnosed major vascular risk factors were seen for lower age, non-Caucasian ethnicity, patent foramen ovale, contraceptive use (in those younger than 55), and smoking (in those 55 and older) in multivariate analysis.

Almost two thirds of patients with acute ischemic stroke have at least one undiagnosed major risk factor, new research shows.
The most common of these are dyslipidemia, hypertension, and atrial fibrillation (AF). In addition, many of the study participants were women and were relatively younger.

Low-dose aspirin, statins, lowering of homocysteine, better diabetes control, smoking cessation, and suppression of inflammatory response increase clot permeability and susceptibility to lysis. Growing evidence indicates that abnormal fibrin properties represent a novel risk factor for arterial and venous thrombotic events, particularly of unknown etiology in young and middle-aged patients.

Despite numerous successful drug studies in rodents, translation of promising results to men has turned out to be a great challenge in acute ischemic stroke (AIS) research. To prevent futile clinical trials in humans, STAIR and RIGOR guidelines recommend studies in multiple species, including a gyrencephalic species. Rather than rodents, large animal gyrencephalic species allow for studies in a larger brain, with a structure that is more similar to the human brain. Larger species, such as swine, dogs, sheep and non-human primates can undergo imaging and catheterization procedures using the exact same clinical devices to further increase translational capacity. Furthermore, the larger circulating volume provides many opportunities in biomarker research that can be matched to clinical trial sampling strategies.

The use of stent-grafts to treat coronary aneurysms is feasible and safe in the long-term. Randomized clinical trials are needed to decide what the best treatment is for these complex lesions.

“In patients with established cerebrovascular disease, a twice-yearly dosing with inclisiran (after the initial and 3-month doses) provided sustained additional LDL-C reduction of [approximately] 55%,” the researchers wrote in the poster abstract. “Inclisiran was well tolerated in patients with established cerebrovascular disease, with a safety profile consistent with that observed in the overall Phase III trial population; a modest excess of treatment emergent adverse events at the injection site were reported with inclisiran, but all were mild or moderate in severity.”

Poor air quality may increase the risk of in-hospital death among patients with ischemic stroke by up to 24%, depending on the size of air pollution particles, new research shows. Investigators found that mortality risk was highest among ischemic stroke patients who had prolonged exposure to air pollution, especially to small particulate matter (PM), such as soot and smog.

The program has made expert stroke care quickly available to patients, even at rural facilities with limited staffing. The telemedicine program connects a neurologist to the smaller clinic or a VA hospital where they do not have a neurologist staffed. A video assessment can be made of the patient and computed tomography (CT) medical imaging can be shared remotely to determine the type of stroke. This can help quickly determine treatment with tissue plasminogen activator (tPA), or transferring a patient quickly to a center that offers catheter-based thrombectomy to revascularize the patient.

The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults who are ages 40 to 75 years, have one or more of the following CVD risk factors (dyslipidemia, diabetes, hypertension, or smoking), and have an estimated 10-year risk of a cardiovascular event of 10% or greater.

Vitamin D has a beneficiary effect on the cardiovascular system, particularly in lessening atherosclerosis, ischemic stroke, and MI. Calcitriol might accelerate vascular regeneration and repair, whereas deficiency has a deleterious effect on vascular endothelium.

Severe VD deficiency is an emerging, strong negative predictor for survival after IS, independent of age and functional status. VD supplementation in stroke survivals may be considered. There is a need to perform a clinical randomized controlled study to demonstrate whether VD supplementation improves an IS patient’s survival.

Definitive diagnosis of acute ischemic stroke is challenging, particularly in telestroke settings. Although the prognostic utility of CT perfusion (CTP) has been questioned, its diagnostic value remains under-appreciated, especially in cases without an easily visible intracranial occlusion. We assessed the diagnostic accuracy of routine CTP in the acute telestroke setting.

Reperfusion therapies (thrombolysis and thrombectomy) are of paramount importance for the recovery after ischemic stroke. We aimed to investigate if socioeconomic status (SES) was associated with the chance of receiving reperfusion therapy for ischemic stroke in a country with tax-funded health care.